# Orthodontic Treatment with Shorty Carriers

# Question

Anyone seen Carriere appliances cause the 6s go into crossbite.  55yr old male.  I did a shorty and I’ve stalled with distalization even doubling up elastics.  Would doubling up elastics potentially cause this as an unwanted effect?  Got great deep bite correction as usual but I’ve never seen it cause a crossbite like this?


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# Answer:

[https://www.loom.com/share/b8ad32fa7ac94e998e05cc6da024a754?sid=6a9eca8d-85d2-4def-905f-0de217ff3e72](https://www.loom.com/share/b8ad32fa7ac94e998e05cc6da024a754?sid=6a9eca8d-85d2-4def-905f-0de217ff3e72)


In orthodontic cases involving Carriere Distalizers, especially the shorter "shorty" Carriere, the elastic bands can create a constricting effect on the teeth. This effect is commonly observed in patients who are in a molar Class II relationship and using a shorty Carriere attached from the upper first premolar to the upper first molar. The elastics effectively distalize or shift the teeth backward, but this can also cause an unintended constriction on the upper first molar.

#### Addressing Constriction with Crossbite Elastics

To counteract this constriction during treatment, clinicians can introduce crossbite elastics. For instance, placing buttons on the upper first molars (referred to as the "upper sixes") and the upper first premolars (or "upper fours") enables the use of crossbite elastics that correct the constricted effect. In cases where distalization is already complete, crossbite elastics can be attached from the buccal (outer) side of the lower second molar to the lingual (inner) side of the upper first premolar.

In one example case, a crossbite elastic was added on the left side, attaching the lower second molar to the upper second molar to further address the constrictive impact of the Carriere. This approach allowed for the creation of a proper occlusal alignment, correcting the crossbite induced by the Carriere Distalizer.

#### Proactive Use of Crossbite Elastics with Shorty Carriere Distalizers

An effective solution to prevent constriction effects from the outset is to use crossbite elastics simultaneously with the Carriere from the beginning of treatment. When using a shorty Carriere, the initial elastic configuration typically involves running the elastic from the lower second molar to the upper first premolar. By introducing crossbite elastics as well, clinicians can run them from the lower first molar to the upper first molar’s lingual side. This setup ensures that the patient wears two elastics on each side: one for the Carriere, connecting the lower second molar to the upper first premolar, and a crossbite elastic from the lower first molar (buccal) to the upper first molar (lingual).

#### Considerations and Potential Risks

While Carriere Distalizers can be effective, some precautions are necessary, particularly with shorty Carriere appliances. In certain cases, particularly in adult male patients who have poor oral hygiene or are smokers, there has been an observed risk of periodontal bone loss around the tooth to which the Carriere is attached. This potential for bone loss has led to more selective use of Carriere appliances to avoid compromising periodontal health in vulnerable cases.